Lone Paroksizmal Atriyal Fibrilasyonu Olan Hastalarda Endotel Fonksiyonları, İntra-Interatriyal İleti Özellikleri ve Diyastolik Fonksiyonlar Arasındaki İlişkinin Değerlendirilmesi
Özet
Risk factors such as endothelial dysfunction, diastolic dysfunction and non-homogeneous atrial conduction, alone or in association with each other may lead to atrial remodelling and play a role in development and maintenance of atrial fibrillation (AF). The aim of this study is to evaluate inflammation, endothelial function, intra-interatrial conduction properties and diastolic functions in lone paroxysmal AF (LPAF) patients, compare them with the control group similar in age and gender, show their role in LPAF determination in patients with normal sinus rhythm and reveal whether there is a relationship between them. 40 patients with newly diagnosed LPAF (22 women, mean age 47,68±8,47) and 40 healthy volunteers (29 women, mean age 48,95±7,09) were enrolled for this study. Diastolic functions evaluated by transthorasic echocardiography, brachial artery flow-mediated dilation (FMD) method was performed for endothelial function and high-sensitive CRP (hsCRP) levels were measured. 12-lead surface electrocardiogram (ECG) was performed for calculation of the P-wave dispersion (Pd) value and the signal-averaged ECG (SAECG) was used to measure filtered P-wave duration. Left atrial dimensions were significantly higher in LPAF group than control group (p <0.05). FMD % in LPAF group was significantly lower than the control group (5.27 % versus 6.65 %, p = 0.001). The mean Pd value was calculated 51.63 ± 11.17 ms in LPAF group and 35.13 ± 6.15 ms in control group (p = 0.001). Filtered P-wave duration was 146.75 ± 19.68 ms in LPAF group and 124,4±9.05 ms in the control group (p = 0.001). The median value of hsCRP levels in LPAF and control groups was 0.4 mg/dl and 0.24 mg/dl, respectively (p = 0.001). There was negative and significant correlation between FMD % and hsCRP, left atrial volume index (LAVI), Pd and SAECG P wave duration. Also there was positive correlation between Pd and hsCRP, LAVI, SAECG P wave duration and E/E?(septal). Lastly there was positive and significant correlation between SAECG P wave duration and hsCRP levels and E/E '(septal). In univariate logistic regression analysis; LAVI,E/E '(septal), Pmax, SAECG P-wave duration, Pd, hsCRP, E, E/A ratio and FMD % were found related with the development of LPAF. In multivariate logistic regression analysis, LAVI, Pd, SAECG P wave duration, E, and E/E'(septal) were found as independent predictors of LPAF. In conclusion, our study showed that diastolic dysfunction, inflammation, intra-interatrial conduction abnormalities and endothelial dysfunction are interrelated and may play an important role in determination of LPAF in patients with normal sinus rythm.
